Not sure what it's all about.
> Background: Clinicians routinely refer to hypotension as a
> systolic blood
> pressure (SBP) <=90 mm Hg.
No they don't. Clinicians usually use it to mean SBP <
120.
> However, few data exist to support
> the rigid
> adherence to this arbitrary cutoff.
Which may explain why there is not rigid adherance to it.
> We hypothesized that the
> physiologic
> hypoperfusion and mortality outcomes classically associated with
> hypotension were manifest at higher SBPs.
As has been the general view for a long time. Every basic course (ATLS, ALS, ALERT etc. etc.) teaches that hypotension is a late and unreliable sign of shock.
Really all I can see this paper saying is that hypotension is a marker of severity. OK, fair enough, TRISS doesn't count it for a score until SBP drops below 90, but the APACHE score and the various MEWS/ SEWS etc. scores cut in at 110 systolic. They may be making a case for altering the TRISS score, but the conclusion about what is clinically relevant is unwarranted given that most people already consider higher BPs as being hypotension.
btw, keep an eye out for my article next month on "Egg Sucking: some helpful pointers for the older clinician".
Matt Dunn
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